title: The immune system in critical illness.
abstract: The mammalian immune system comprises a complex network of physical and molecular elements that protect the individual from danger in the environment. An evolutionarily ancient innate immune system recognizes danger through pattern-recognition receptors that are encoded in the genome and mobilizes a rapid and potent but nonspecific response. This response is responsible for the clinical syndromes of sepsis and the multiple organ dysfunction syndrome. The adaptive immune system is highly selective in its targets and is endowed with memory but is slow in initial activation. Critical illness results in derangements of all components of the immune response, but the very complexity of the process has frustrated attempts to correct these derangements and to affect significantly the clinical course of sepsis.
authors.affiliation: Interdepartmental Division of Critical Care, St. Michael's Hospital, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada M5B 1W8. marshallj@smh.toronto.on.ca
authors.forename: John C
authors.initials: JC
authors.lastname: Marshall
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Charbonney
authors.forename: Patricia Duque
authors.initials: PD
authors.lastname: Gonzalez
mesh_terms: D001424:Bacterial Infections / Q000276:immunology; D018988:Bacterial Translocation / Q000276:immunology; D005075:Biological Evolution; D024201:Bystander Effect / Q000276:immunology; D016638:Critical Illness; D016207:Cytokines / Q000097:blood; D006801:Humans; D007110:Immunity, Active / Q000276:immunology; D007111:Immunity, Cellular / Q000276:immunology; D007113:Immunity, Innate; D018805:Sepsis / Q000276:immunology* / Q000628:therapy; D051193:Toll-Like Receptors / Q000097:blood
chemical_list: D016207:Cytokines; D051193:Toll-Like Receptors